<i>Mechanisms in Development of Interstitial Emphysema and Air Embolism on Decompression From Depth</i>

Schaefer, Karl E.; McNulty, Wilbur P.; Carey, Charles R.; Liebow, Averill A.

doi:10.1152/jappl.1958.13.1.15

Cited by 110 publications

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“…During ascent, lung volume expands and the diver must exhale in order to keep intrapulmonary pressures close or equal to the surrounding pressure. If the diver does not exhale properly, lung volume increases, with overdistention of alveoli and bronchi leading to possible rupture [33]. The usual reason for pulmonary barotrauma is the diver's ascending technique.…”

Section: Pulmonary Barotraumamentioning

confidence: 99%

Sports-related lung injury during breath-hold diving

Mijačika

Dujić

2016

Eur Respir Rev

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The number of people practising recreational breath-hold diving is constantly growing, thereby increasing the need for knowledge of the acute and chronic effects such a sport could have on the health of participants. Breath-hold diving is potentially dangerous, mainly because of associated extreme environmental factors such as increased hydrostatic pressure, hypoxia, hypercapnia, hypothermia and strenuous exercise.In this article we focus on the effects of breath-hold diving on pulmonary function. Respiratory symptoms have been reported in almost 25% of breath-hold divers after repetitive diving sessions. Acutely, repetitive breath-hold diving may result in increased transpulmonary capillary pressure, leading to noncardiogenic oedema and/or alveolar haemorrhage. Furthermore, during a breath-hold dive, the chest and lungs are compressed by the increasing pressure of water. Rapid changes in lung air volume during descent or ascent can result in a lung injury known as pulmonary barotrauma. Factors that may influence individual susceptibility to breath-hold diving-induced lung injury range from underlying pulmonary or cardiac dysfunction to genetic predisposition.According to the available data, breath-holding does not result in chronic lung injury. However, studies of large populations of breath-hold divers are necessary to firmly exclude long-term lung damage. @ERSpublications Breath-hold diving may result in acute respiratory symptoms, but does not lead to chronic lung dysfunction http://ow.ly/D03r302uMOD

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Section: Pulmonary Barotraumamentioning

confidence: 99%

Sports-related lung injury during breath-hold diving

Mijačika

Dujić

2016

Eur Respir Rev

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“…houstonmethodist.org/debakey-journal and arterial gas embolism. 44,45 The lung injury and air in the arterial system results in a number of well-defined clinical manifestations (Table 2), the most serious of which is injury to the brain due to cerebral air embolism. This syndrome produces stroke-like manifestations in a diver immediately upon ascent.…”

Section: Boyles Law Effects On Lung Volume-pulmonary Barotraumamentioning

confidence: 99%

Pulmonary Aspects of Exercise and Sports

Bové

2016

Methodist DeBakey Cardiovascular Journal

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Although the lungs are a critical component of exercise performance, their response to exercise and other environmental stresses is often overlooked when evaluating pulmonary performance during high workloads. Exercise can produce capillary leakage, particularly when left atrial pressure increases related to left ventricular (LV) systolic or diastolic failure. Diastolic LV dysfunction that results in elevated left atrial pressure during exercise is particularly likely to result in pulmonary edema and capillary hemorrhage. Data from race horses, endurance athletes, and triathletes support the concept that the lungs can react to exercise and immersion stress with pulmonary edema and pulmonary hemorrhage. Immersion in water by swimmers and divers can also increase stress on pulmonary capillaries and result in pulmonary edema. Swimming-induced pulmonary edema and immersion pulmonary edema in scuba divers are well-documented events caused by the fluid shifts that occur with immersion, elevated pulmonary venous pressure during extreme exercise, and negative alveolar pressure due to inhalation resistance. Prevention strategies include avoiding extreme exercise, avoiding over hydration, and assuring that inspiratory resistance is minimized. Figure 1. Pulmonary capillary wedge pressure (PCWP) measured during increasing exercise intensity, determined by oxygen consumption (VO 2 ), in well-trained (circles) and average-trained (squares) men with a mean age of 29.6. Note that the well-trained subjects preserved normal levels of PCWP until they reached high levels of exercise, while the average-trained men demonstrated increases in PCWP at lower levels of exercise intensity. Adapted from Stickland et al. 4MDCVJ | XII (2) 2016 94 houstonmethodist.org/debakey-journal of interstitial hemorrhage and fluid accumulation following a high workload in one horse that developed EIPH. West et al. 9 suggested that two factors contributed to this problem in horses: (1) They were likely to have a congenital weakness of pulmonary capillaries that resulted in capillary rupture at high pulmonary venous and capillary pressure, and (2) they developed high pulmonary venous pressure due to failure of the left ventricle with subsequent elevation of LV end diastolic pressure during high workloads.Human studies of lung responses to high workloads 10 corroborate the studies of West et al. to some extent. Zavorsksy et al. 11 studied individuals under several different workloads and performed lung imaging to document the presence or absence of lung edema. Radiographic image readers were blinded to the exposures and reported visual evidence of lung fluid. In individuals undergoing a diagnostic graded exercise test, no evidence of lung edema was noted. However, 15% of individuals who ran on a treadmill at 70% of maximum capacity for 2 hours demonstrated evidence of pulmonary edema, as did 65% of those who ran at maximum capacity for 7 minutes. Similar findings were noted in female athletes.12 Pingitore et al. examined 48 athletes before and aft...

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“…Theoretically, in asthmatic divers with airways obstruction and air trapping, during ascent, the lung volume in lung regions with air trapping will increase, with overdistension of the alveoli and bronchi leading to lung rupture. A transpulmonary pressure of 95-110 cmH 2 O is sufficient to disrupt the pulmonary parenchyma and force gas into the interstitium [9,10]. When alveolar rupture occurs, gas infiltrates the peribronchial space and causes pulmonary interstitial emphysema, pneumomediastinum or pneumothorax [11,12].…”

Section: Diving Physiology and Pulmonary Barotraumamentioning

confidence: 99%

Can asthmatic subjects dive?

Adir

Bové

2016

Eur Respir Rev

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Recreational diving with self-contained underwater breathing apparatus (scuba) has grown in popularity. Asthma is a common disease with a similar prevalence in divers as in the general population. Due to theoretical concern about an increased risk for pulmonary barotrauma and decompression sickness in asthmatic divers, in the past the approach to asthmatic diver candidates was very conservative, with scuba disallowed. However, experience in the field and data in the current literature do not support this dogmatic approach. In this review the theoretical risk factors of diving with asthma, the epidemiological data and the recommended approach to the asthmatic diver candidate will be described. @ERSpublicationsThe theoretical risks of diving with asthma, epidemiological data and the recommended approach to asthmatic divers http://ow.ly/105KuZ

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Mechanisms in Development of Interstitial Emphysema and Air Embolism on Decompression From Depth

Cited by 110 publications

References 0 publications

Sports-related lung injury during breath-hold diving

Sports-related lung injury during breath-hold diving

Pulmonary Aspects of Exercise and Sports

Can asthmatic subjects dive?

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